HOSPITAL PHARMACY DECISIONS, COST-CONTAINMENT, AND THE USE OF COST-EFFECTIVENESS ANALYSIS

The key hypothesis of the study was that hospital pharmacies under the pressure of managed care would be more likely to adopt process innova tions to assure less costly and more cost-effective provision of care. We conducted a survey of 103 hospitals and analyzed secondary data on cost and staffing. Compared to the size of the reduction in length of stay, changes in the way that a day of care is delivered appear to be minor, even in areas with substantial managed care share. The vast ma jority of hospitals surveyed had implemented some form of therapeutic interchange and generic substitution. Most hospitals used some drug ut ilization guidelines, but as of mid 1995 these were not yet important management tools for hospital pharmacies. To our knowledge, ours was t he first survey to investigate the link between hospital formularies a nd use of cost-effectiveness analysis. At most cost-effectiveness was a minor tool in pharmaceutical decision making in hospitals at present . We could determine no differences in use of such analyses by managed care market share in the hospital's market share. One impediment to t he use of cost-effectiveness studies was the lack of timeliness of stu dies. Other stated reasons for not using cost-effectiveness analysis m ore often were: lack of information on hospitalized patients and hence on the potential cost offsets accruing to the hospital: lack of indep endent sponsorship, and inadequate expertise in economic evaluation. ( C) 1997 Elsevier Science Ltd.